Clinical, organisational and policy factors influencing the implementation of nurse-led models of long-acting reversible contraception and medication abortion care in Australian general practice: A qualitative exploration

SSM - Health Systems Pub Date : 2025-07-02 DOI:10.1016/j.ssmhs.2025.100095

Jessica E. Moulton , Noushin Arefadib , Jessica R. Botfield , Karen Freilich , Danielle Mazza

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Abstract

Background

Access to sexual and reproductive healthcare in rural and regional areas is often limited, particularly for contraception and abortion care. Nurse-led models of care offer a promising solution, yet their implementation and evaluation in Australian primary care remain underexplored. We therefore examined stakeholders’ perceptions of clinical, organisational and policy factors influencing the adoption of nurse-led contraception and abortion care in rural and regional Australian general practice.

Methods

A secondary analysis of qualitative data from a co-design workshop, aimed at developing a nurse-led model of care, was conducted. Participants included consumers, nurses, physicians, practice managers, community and advocacy organisation representatives, academics, and policymakers. The secondary analysis focused solely on data related to clinical, organisational, and policy factors that may influence the implementation of nurse-led contraception (involving contraceptive implant insertion) and medication abortion in rural and regional general practice. The Consolidated Framework for Implementation Research guided data analysis to enrich our understanding of implementation factors.

Results

Fifty-two stakeholders participated in the workshop. Five themes were constructed: 1) the influences on nurses' capability to work to their full scope of practice, 2) formalising general practitioner-nurse partnerships for model sustainability, 3) integrating practice-based nurse training, 4) medico-legal implications for collaborative care and 5) leveraging funding models to support nurse-led care.

Conclusion

Successful implementation of nurse-led contraception and medication abortion care requires improved funding models to ensure adequate nurse and practice remuneration, strengthened nurse-general practitioner partnerships, and employer support for ongoing nurse education. Policies fostering collaborative, multidisciplinary care will enhance the sustainability and effectiveness of these models in general practice.

Reporting method

Reported in line with the Standards for Reporting Qualitative Research (SRQR) checklist.

Patient or public contribution

Two consumer representatives contributed to the development of the co-design methodology as members of the ORIENT Intervention Advisory Group Governance Committee.

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临床、组织和政策因素影响护士主导的长效可逆避孕和药物流产护理模式在澳大利亚全科实践中的实施：一项定性探索

农村和区域地区获得性保健和生殖保健的机会往往有限，特别是避孕和堕胎护理。护士主导的护理模式提供了一个有希望的解决方案，但他们的实施和评估在澳大利亚初级保健仍未充分探索。因此，我们检查了利益相关者对临床、组织和政策因素的看法，这些因素影响了澳大利亚农村和地区全科医生采用护士主导的避孕和堕胎护理。方法对旨在建立护士主导的护理模式的共同设计研讨会的定性数据进行二次分析。参与者包括消费者、护士、医生、实践经理、社区和倡导组织代表、学者和政策制定者。次要分析仅侧重于与临床、组织和政策因素相关的数据，这些因素可能影响在农村和地区全科实践中实施护士主导的避孕（包括植入避孕药具）和药物流产。《实施研究综合框架》指导数据分析，以丰富我们对实施因素的理解。结果52名利益相关者参加了研讨会。本研究构建了五个主题：1)对护士全面工作能力的影响；2)使全科医生与护士的合作关系正规化，以实现模式的可持续性；3)整合基于实践的护士培训；4)协同护理的医学-法律含义；5)利用资助模式支持护士主导的护理。结论护士主导的避孕和药物流产护理的成功实施需要改进资助模式，以确保护士和执业人员获得足够的报酬，加强护士与全科医生的伙伴关系，以及雇主对护士持续教育的支持。促进协作、多学科护理的政策将提高这些模式在全科实践中的可持续性和有效性。报告方法按照定性研究报告标准（SRQR）清单进行报告。患者或公众贡献两名消费者代表作为东方干预咨询小组治理委员会的成员对共同设计方法的发展做出了贡献。

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SSM - Health Systems

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